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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. Washington, DC: The National Academies Press. doi: 10.17226/25837.
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Respiratory
Health Effects of
Airborne Hazards Exposures
in the Southwest Asia
Theater of Military
Operations

Committee on the Respiratory Health Effects of
Airborne Hazards Exposures in the
Southwest Asia Theater of Military Operations

Board on Population Health and Public Health Practice

Health and Medicine Division

A Consensus Study Report of

images

THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. Washington, DC: The National Academies Press. doi: 10.17226/25837.
×

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

This activity was supported by Contract Order No. 36C24E18C0068 between the National Academy of Sciences and the Department of Veterans Affairs. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-67910-7
International Standard Book Number-10: 0-309-67910-9
Digital Object Identifier: https://doi.org/10.17226/25837

Additional copies of this publication are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.

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Printed in the United States of America

Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2020. Respiratory health effects of airborne hazards exposures in the Southwest Asia Theater of Military Operations. Washington, DC: The National Academies Press. https://doi.org/10.17226/25837.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. Washington, DC: The National Academies Press. doi: 10.17226/25837.
×

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The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president.

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Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. Washington, DC: The National Academies Press. doi: 10.17226/25837.
×

Image

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task.

Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies.

For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. Washington, DC: The National Academies Press. doi: 10.17226/25837.
×

COMMITTEE ON THE RESPIRATORY HEALTH EFFECTS OF AIRBORNE HAZARDS EXPOSURES IN THE SOUTHWEST ASIA THEATER OF MILITARY OPERATIONS

MARK J. UTELL (Chair), Professor of Medicine and Environmental Medicine, Director of Occupational and Environmental Medicine, former Director of Pulmonary and Critical Care Medicine, University of Rochester Medical Center

LUNG-CHI CHEN, Professor, Department of Environmental Medicine, New York University Grossman School of Medicine

ELLEN A. EISEN, Professor, School of Public Health, University of California, Berkeley

MEREDITH FRANKLIN, Associate Professor, Division of Biostatistics, Keck School of Medicine, University of Southern California; Director of MS Programs in Biostatistics, Health Data Sciences, and Epidemiology

KIRK D. JONES, Clinical Professor, University of California, San Francisco

MEREDITH C. MccORMAcK, Associate Professor of Medicine and Medical Director, Pulmonary Function Laboratory, Johns Hopkins University; Vice Chair, American Thoracic Society Committee for Proficiency Standards in Pulmonary Function Testing

CECILE S. ROSE, Professor of Medicine, National Jewish Health, Division of Environmental and Occupational Health Sciences, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine

FRANK E. SPEIZER, Professor of Environmental Science, Harvard T.H. Chan School of Public Health, Edward H. Kass Distinguished Professor of Medicine, Harvard Medical School ELAINE SYMANSKI, Professor, Center for Precision Environment Health, Department of Medicine, Baylor College of Medicine SVERRE VEDAL, Professor Emeritus, Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington

JODY WIREMAN, Environmental Health Advisor, Defense Health Agency

Study Staff

DAVID A. BUTLER, Scholar and Study Director

ELIZABETH BARKSDALE BOYLE, Program Officer

CHRISTINA R. SAMUEL, Research Associate

REBECCA F. CHEVAT, Senior Program Assistant

ANNE N. STYKA, Senior Program Officer

KRISTIN E. WHITE, Associate Program Officer

ROSE MARIE MARTINEZ, Senior Director, Board on Population Health and Public Health Practice

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. Washington, DC: The National Academies Press. doi: 10.17226/25837.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. Washington, DC: The National Academies Press. doi: 10.17226/25837.
×

Reviewers

This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.

We thank the following individuals for their review of this report:

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report, nor did they see the final draft before its release. The review of this report was overseen by SANDRO GALEA, Boston University School of Public Health, and DAVID A. SAVITZ, Brown University. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.

Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. Washington, DC: The National Academies Press. doi: 10.17226/25837.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. Washington, DC: The National Academies Press. doi: 10.17226/25837.
×

Acknowledgments

The committee could not have written this report without the help of a number of people. We wish to particularly thank the presenters and participants in our October 2019 workshop—listed in Appendix A—who shared their expertise and perspectives on respiratory health issues in veterans and the research that might allow a better understanding of them. Drs. R. Loren Erickson and Eric Shuping of the Department of Veterans Affairs also briefed the committee and responded to our follow-up questions.

The committee members are very appreciative of the outstanding efforts of the staff of the National Academies of Sciences, Engineering, and Medicine’s Health and Medicine Division, who supported us in our work, David Butler, who served as study director; and Elizabeth Boyle, Christina Samuel, Anne Styka, Kristin White, and Stephanie Hanson, who had a daunting task of identifying and culling the large and complex literature we reviewed and more generally guiding and assisting the committee in its mission. We are also very grateful to Rebecca Chevat for capably providing logistical support. Finally, we would like to acknowledge Jorge Mendoza, a senior research librarian who conducted the literature searches for the committee, and Misrak Dabi, the financial business partner for the project.

Mark J. Utell, Chair
Committee on the Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. Washington, DC: The National Academies Press. doi: 10.17226/25837.
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Page xiii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. Washington, DC: The National Academies Press. doi: 10.17226/25837.
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Acronyms and Abbreviations

AEP acute eosinophilic pneumonia
AFRL Air Force Research Laboratory
AH&OBP Airborne Hazards and Open Burn Pit
AHBPCE VA Airborne Hazards and Burn Pits Center of Excellence
AHCE Airborne Hazards Center of Excellence
ARDS acute respiratory distress syndrome
ATS American Thoracic Society
BALF bronchoalveolar lavage fluid
BMI body mass index
CARC chemical agent resistant coating
CBRNE Chemical, Biological, Radiological, Nuclear, and high yield Explosives
CDC Centers for Disease Control and Prevention
CDMRP Congressionally Directed Medical Research Programs
CHAI Comparative Health Assessment Interview
CHPPM U.S. Army Center for Health Promotion and Preventive Medicine
CI confidence interval
CMS Centers for Medicare & Medicaid Services
COPD chronic obstructive pulmonary disease
CT computed tomography
DARPA Defense Advanced Research Projects Agency
DECAMP Detection of Early Lung Cancer Among Military Personnel
DHA Defense Health Agency
DHB Defense Health Board
DL/VA the ratio of DLCO to alveolar volume
DLCO diffusing capacity of the lung to carbon monoxide
DMDC Defense Manpower Data Center
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. Washington, DC: The National Academies Press. doi: 10.17226/25837.
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DMSS Defense Medical Surveillance System
DoD Department of Defense
DoDSR Department of Defense Serum Repository
DOEHRS-IH Defense Occupational and Environmental Health Readiness System–Industrial Hygiene
DSRR directly standardized relative risk
DU depleted uranium
ECG electrocardiogram
ECRHS European Community Respiratory Health Survey
EHR electronic health record
EPA Environmental Protection Agency
EPMSP Enhanced Particulate Matter Surveillance Program
ERS European Respiratory Society
ESA European Space Agency
FEF forced expiratory flow
FEV forced expiratory volume
FEV1 forced expiratory volume in 1 second
FOT forced oscillation technique
FRC functional residual capacity
FVC forced vital capacity
GINA Global Initiative for Asthma
GM-CSF granulocyte-macrophage colony-stimulating factor
GOLD Global Initiative for Chronic Obstructive Lung Disease
HR hazard ratio
HYSPLIT Hybrid Single Particle Lagrangian Integrated Trajectory
ICD-9-CM International Classification of Diseases, Ninth Edition, Clinical Modification
IgA immunoglobulin A
IIP idiopathic interstitial pneumonia
ILER Individual Longitudinal Exposure Record
IOM Institute of Medicine
IOS impulse oscillometry
IPF idiopathic pulmonary fibrosis
IR incidence rate
IRB institutional review board
IRR incidence rate ratio
JPC Joint Pathology Center
LCI lung clearance index
LLN lower limit of normal
LTBI latent tuberculosis infection
MAIA Multi-Angle Imager for Aerosols
MeSH medical subject heading
miRNA micro RNA
MISR Multi-angle Imaging SpectroRadiometer
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. Washington, DC: The National Academies Press. doi: 10.17226/25837.
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MODIS Moderate Resolution Imaging Spectroradiometer
MOS military occupational specialty
MRE meals, ready-to-eat
MRR mortality rate ratio
n population size
NAAQS National Ambient Air Quality Standards
NAS National Academy of Sciences
NASA National Aeronautics and Space Administration
n.d. no date
NewGen National Health Study for a New Generation of U.S. Veterans
NF-κB nuclear factor kappa B
NHANES National Health and Nutrition Examination Survey
NHLBI National Heart, Lung, and Blood Institute
NHS National Health Survey of Gulf War Veterans and Their Families
NIEHS National Institute of Environmental Health Sciences
NIH National Institutes of Health
NIOSH National Institute for Occupational Safety and Health
NOAA National Oceanic and Atmospheric Administration
NRC National Research Council
OEF Operation Enduring Freedom
OIF Operation Iraqi Freedom
OMI Ozone Mapping Instrument
OND Operation New Dawn
OR odds ratio
p p-value
PAH polycyclic aromatic hydrocarbon
PAP pulmonary alveolar proteinosis
PCB polychlorinated biphenyl
PCDD/F polychlorinated dibenzo-p-dioxin and dibenzo-p-furan
PDF portable document format
PET positron emission tomography
PFT pulmonary function test
pIgR polymeric immunoglobulin receptor
PIR proportional incidence ratio
PL Public Law
PM particulate matter
POEMS periodic occupational and environmental monitoring summary
PTSD posttraumatic stress disorder
RAC Research Advisory Committee on Gulf War Veterans’ Illnesses
Raw airways resistance
RD rate difference
RFI request for information
RR rate ratio
RV residual volume
SHADE Service and Health Among Deployed Veterans
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. Washington, DC: The National Academies Press. doi: 10.17226/25837.
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SIR standardized incidence ratio
SMR standardized mortality ratio
SPIROLA Spirometry Longitudinal Data Analysis
SSIC signs, symptoms, and ill-defined conditions
STAMPEDE Study of Active Duty Military for Pulmonary Disease Related to Environmental Deployment Exposures
TB tuberculosis
TBI traumatic brain injury
TLC total lung capacity
TSP total suspended particles
VA Department of Veterans Affairs
VHA Veterans Health Administration
VO2 volume of oxygen (O2)
VOC volatile organic compound
WHO World Health Organization
WRIISC VA War Related Illness and Injury Study Center
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. Washington, DC: The National Academies Press. doi: 10.17226/25837.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. Washington, DC: The National Academies Press. doi: 10.17226/25837.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. Washington, DC: The National Academies Press. doi: 10.17226/25837.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. Washington, DC: The National Academies Press. doi: 10.17226/25837.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. Washington, DC: The National Academies Press. doi: 10.17226/25837.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. Washington, DC: The National Academies Press. doi: 10.17226/25837.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. Washington, DC: The National Academies Press. doi: 10.17226/25837.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. Washington, DC: The National Academies Press. doi: 10.17226/25837.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. Washington, DC: The National Academies Press. doi: 10.17226/25837.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. Washington, DC: The National Academies Press. doi: 10.17226/25837.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. Washington, DC: The National Academies Press. doi: 10.17226/25837.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. Washington, DC: The National Academies Press. doi: 10.17226/25837.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. Washington, DC: The National Academies Press. doi: 10.17226/25837.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. Washington, DC: The National Academies Press. doi: 10.17226/25837.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. Washington, DC: The National Academies Press. doi: 10.17226/25837.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. Washington, DC: The National Academies Press. doi: 10.17226/25837.
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More than 3.7 million U.S. service members have participated in operations taking place in the Southwest Asia Theater of Military Operations since 1990. These operations include the 1990-1991 Persian Gulf War, a post-war stabilization period spanning 1992 through September 2001, and the campaigns undertaken in the wake of the September 11, 2001, attacks. Deployment to Iraq, Kuwait, Saudi Arabia, Bahrain, Gulf of Aden, Gulf of Oman, Oman, Qatar, the United Arab Emirates, and Afghanistan exposed service members to a number of airborne hazards, including oil-well fire smoke, emissions from open burn pits, dust and sand suspended in the air, and exhaust from diesel vehicles. The effects of these were compounded by stressors like excessive heat and noise that are inevitable attributes of service in a combat environment.

Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations reviews the scientific evidence regarding respiratory health outcomes in veterans of the Southwest Asia conflicts and identifies research that could feasibly be conducted to address outstanding questions and generate answers, newly emerging technologies that could aid in these efforts, and organizations that the Veterans Administration might partner with to accomplish this work.

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